Does patient rurality predict quality colon cancer care? a population based study

Abstract

Introduction: Over fifty million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized. We hypothesize that patient rurality impacts colon cancer care quality measures. Methods:Using the 1996-2008 California Cancer Registry, we identified 123,129 patients with stage 0-IV colon cancer. Baseline characteristics were compared by rurality status. Controlling for covariates, multivariate regression models were used to examine the impact of rurality on stage, adequate lymphadenectomy and receipt of chemotherapy. Cox proportional hazards was used to examine cancer specific survival. Results: Of our cohort, 18,735 (15%) resided in rural areas. Rural residence was associated with white or American Indian race. Controlling for covariates, our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy and inadequate receipt of chemotherapy. In addition, rurality was associated with worse cancer specific survival. Conclusions: A significant proportion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with later stage, poor adherence to quality measures and poorer survival. Future quality improvement measures should target rural patients to ensure both that structure of care is optimal and that appropriate processes of care are followed.